Doin, Jean NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jean Marie Doin Female
Date of Death Age If Veteran of U.S. Armed Forces,
09/15/2018 73 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls8 Street Address Glens Falls Hospital
tp Manner of Death�Natural Cause Accident Homicide n Suicide Undetermined n Pending
1.1 Circumstances Investigation
t j Medical Certifier Name Title
a Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 438
[Burial Date Cemetery or Crematory
09/17/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
2
and/or Address
tfi Hold
Date Point of
❑Transportation Shipment
ES by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
!
W
11.. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/17/2018 Registrar of Vital Statistics [Robert, Curtis(E(ectronicattySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
liJ Date of Disposition lIIg Iig Place of Disposition l'4V (elA.+ d�.
(address)
Di
CC (section) (lot num r) ( (grave number)
0 Name of Sexton or Person in Charge of Premises �t,4Pl/' )eA.a
Zs (please print) i,,
W Signatureii-
Title tiritIOA
(over)
DOH-1555 (02/2004)